Nursing Management of Disturbed Behaviour in Aged Care Facilities

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Nursing Management Aged Care FALLS SPECIFIC PROBLEMS – FOLLOW THE ALGORITHM – then consider adding the following strategies: • Assess risk and reassess if change in health status • Review/reduce medication • Provide safe footwear and clothing • Test eyesight and glasses • Provide safe uncluttered environment • Arrange Physiotherapist assessment – balance, gait etc • Provide exercise programme • Maintain walking aids • Consider Hip Protectors, wrist guards, helmet, knee & shoulder pads • See - Wandering • If absolutely necessary – use restraints in the least restrictive way and adhere scrupulously to facility policy • See – Shanley ‘Putting Your Best Foot Forward – Preventing and Managing Falls in Aged Care Facilities’. [34, 55] Inappropriate SEXUAL BEHAVIOURS • Consider lifetime habits, clothing, urinary tract dysfunction • Examine staff & resident’s reactions & debrief • Provide privacy • Provide activity programme • Provide exercise programme • Reinforce appropriate behaviour • Keep verbal response to negative behaviour to a minimum • Assess touch response – if appropriate provide stuffed animals, doll, massage, pets, etc • Increase staff interactions with the person. [47, 48, 49, 58] INCONTINENCE • Assess over several days – when, how often, where, toileting pattern, fluid intake, infections, medications, past history • Provide easily manageable clothing • Provide consistent, appropriate toilet schedule • Provide signs &/or bright colours on toilet doors • Provide protective garments and aids • Maintain good hygiene • Provide privacy and time Specific Issues Specific Interventions • Falls • Inappropriate Sexual Behaviour • Incontinence • Resistance To Care • Screaming / Calling Out • Wandering • If faecal incontinence – assess for & relieve impaction. • Address fibre & fluid intake, increase exercise, schedule to respond to gastro-colic reflex after meals • National Continence Helpline 1800 33 00 66 [4, 52, 53]
RESISTANCE TO CARE • Review when, what, who & social history • Consider how it is being done, privacy, rush • ASK questions & listen to what the person is saying • Change time it is done • Change how it is done (bathe/sponge instead of shower) • Change carer • Provide distraction – music, singing, chat • Provide gentle encouragement, reward • Compromise, simplify – change expectations • Think creatively and laterally. [34, 35, 36] SCREAMING/CALLING OUT • Address PAIN, toilet, loneliness or fear needs • Is there too little or too much stimulation? • Provide meaningful activity programme • Consider ‘Simulated Presence Therapy’ – audio or video recording of familiar people • Assess touch response– if appropriate provide stuffed animals, doll, massage, pets • Consider ‘white noise’- gentle ocean, bird sounds, soft music • Surround with familiar possessions Nursing Management Aged Care • Increase staff interactions with the person at regular time intervals, not only in response to calls • Validate, distract, acknowledge. [45, 46] WANDERING • Provide, safe, secure, interesting wandering area (in & out) • Set up toileting schedule • Provide meaningful activity programme – particularly late afternoon • Consider ‘Simulated Presence Therapy’ – audio or video of familiar people • Assess touch response– if appropriate provide stuffed animals, doll, massage, pets • See - Falls - risk protection • Surround with familiar possessions • Label own room, toilet, etc • Provide exercise programme • Camouflage exits etc • Increase staff interactions with the person • Validate, distract, acknowledge. [37, 44] Remember: Behaviour is a means of communication. The person is not the problem The problem is the problem
Page 1 and 2: Lecture Notes and Resource Kit Pool
Page 3 and 4: Page Poole’s Algorithm Aged Care
Page 5 and 6: Nursing Management Aged Care Figure
Page 7 and 8: Nursing Management Aged Care 1. GIV
Page 9 and 10: Table 1: Potential causes (predispo
Page 11 and 12: 1. The NURSING ASSESSMENT needs to
Page 13 and 14: Nursing Management Aged Care Behavi
Page 15: 4. Instigate consistent plan • Ma
Page 19 and 20: Reference List (Continued) 36. Pack
Page 21 and 22: GERIATRIC DEPRESSION SCALE Appendix
Page 23 and 24: Hayes and Lohse NON-VERBAL DEPRESSI
Page 25 and 26: DEPRESSION/ Mental Disorder ASSESS
Page 27: ISBN No. 0-7313-9352-X

Nursing Management of Disturbed Behaviour in Aged Care Facilities

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